Don't use aspirin, nimesulide (尼美舒利) or metamizole (安乃近) for a child's fever, don't give minors cold medicines that contain metamizole, and measure liquid fever reducers with the dosing device that comes in the box

Cost

Free. When you buy a fever reducer, look at the generic name and the ingredient list.

What you get

Reye's syndrome causes brain disease and fatty change in the liver, and usually appears after influenza or chickenpox. In U.S. national surveillance from 1981 to 1997, 1207 cases were reported in people aged 18 and younger. In 82% of the children, salicylate, an ingredient of aspirin-type drugs, was detected in the blood. The overall case fatality rate was 31%. Warnings about salicylates began in 1980. That year 555 cases were reported, the peak, and from 1987 on there were no more than 36 a year. In 2011 the China Food and Drug Administration (国家食药监局) ruled that oral nimesulide preparations may not be used in children aged 12 and younger. In 2020 the National Medical Products Administration (国家药监局) ruled that metamizole tablets are banned for adolescents and children aged 18 and younger. The metamizole-containing Compound Qinghao Anaijin Tablets (复方青蒿安乃近片), Zhonggan Ling Tablets (重感灵片) and Zhonggan Ling Capsules (重感灵胶囊) are likewise banned at 18 and younger. For measuring medicine, look at the U.S. figures. The U.S. FDA stated in 2011 that infants' acetaminophen drops are 80 mg per 0.8 mL, while the oral liquid for older children is 160 mg per 5 mL. By these two figures, 1 mL of the drops contains about 3 times as much drug as 1 mL of the liquid. The FDA said that having two strengths on the market makes mix-ups easy and can lead to accidental overdose in children, and that measuring devices from different products must never be mixed. A Greek study measured 71 teaspoons and 49 tablespoons from 25 households; filled with water, their capacities ranged from 2.5 mL to 7.3 mL. In a U.S. emergency department study, 42.5% of parents who used teaspoons or tablespoons as the dose unit measured the wrong amount, versus 27.6% of parents who used milliliters only. After adjustment OR 2.3, 95% CI 1.2–4.4 (the odds of a wrong measurement were a little over double).

Notes

Metamizole (安乃近) is not a first choice for adults either. The inserts state that it can cause agranulocytosis, aplastic anemia and anaphylactic shock, and it is to be used briefly only when the condition is acute and serious and no other effective drug is available. Zhonggan Ling (重感灵) sounds like an ordinary cold medicine, but it contains metamizole. Ask a pediatrician or pharmacist what fever reducer to use for a child and how much to give by weight. For a child under 3 months with a fever, go straight to the hospital; see §20.8 (go straight to the hospital at 38 ℃). Graded B because the Reye's syndrome numbers come from surveillance reports, and the fall in cases followed the warning in time but was not a controlled trial. The benefit is rated “large” because after the warning cases fell from 555 a year to 36 or fewer.

Evidence grade

B : Supported by research but without a precise number, or based on small or single studies.

Sources

1. Belay ED, Bresee JS, Holman RC, Khan AS, Shahriari A, Schonberger LB (1999). Reye's syndrome in the United States from 1981 through 1997. New England Journal of Medicine, 340(18):1377-1382. https://doi.org/10.1056/NEJM199905063401801
2. Notice on strengthening the management of the use of oral nimesulide preparations ([2011] No. 209) [in Chinese]. https://www.nmpa.gov.cn/xxgk/fgwj/gzwj/gzwjyp/20110515145101552.html
3. National Medical Products Administration Announcement on revising the package inserts of metamizole (analgin) products (No. 34 of 2020), with Annexes 1 to 3 [in Chinese]. https://www.nmpa.gov.cn/directory/web/nmpa/xxgk/ggtg/ypggtg/ypshmshxdgg/20200317171201660.html
4. U.S. Food and Drug Administration. Questions and Answers – Important change in concentration for over-the-counter (OTC) liquid acetaminophen marketed for infants. https://www.fda.gov/drugs/drug-safety-and-availability/questions-and-answers-important-change-concentration-over-counter-otc-liquid-acetaminophen-marketed
5. Falagas ME, Vouloumanou EK, Plessa E, Peppas G, Rafailidis PI (2010). Inaccuracies in dosing drugs with teaspoons and tablespoons. International Journal of Clinical Practice, 64(9):1185-1189. https://doi.org/10.1111/j.1742-1241.2010.02402.x
6. Yin HS, Dreyer BP, Ugboaja DC, et al. (2014). Unit of measurement used and parent medication dosing errors. Pediatrics, 134(2):e354-e361. https://doi.org/10.1542/peds.2014-0395

Translated from the Chinese original. Original book, section 34, tip 2. This section is about health and medicines. It is general information, not a substitute for a doctor’s diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer